Rural EM folks- reading own films?

[Simplify]

Curious, how many of you rural EM folks (solo coverage) are reading your own films?  Recently started at a solo coverage position which will does not have a radiologist reviewing X-RAYS but will have a radiologist reviewing CTs (remotely).  I have been relatively spoiled until now with radiology interpreting all imaging.  I am not worried about the obvious pneumonia or fracture however the thought of missing a hairline fracture or subtle finding on lateral neck film makes me a little nervous.  Thoughts? Also,  for those of you without 24/7 formal ultrasound what are you doing with folks that need it? (i.e., ovarian torsion, Ectopic pregnancy, DVT workups).  Appreciate the info.

[EMEDPA]

most of the time I don't get real time rad reads, but all studies are read by a radiologist within 72 hrs. CTs and u/s are read by an on-call rads group. I can get a stat read anytime I want from the on-call group by calling. for u/s, we have on-call techs most of the time. If it's a dvt r/o and they are not there we will often give 1st dose lovenox and have them return in am for u/s if suspicion is high. if no u/s is immediately available, I can transfer pts for an u/s(generally a ruq study) and the receiving facility is also where the surgeons are so if the study is + they just stay there.

[sk732]

Where I work, if it's during normal hours, I can go to the rad in person for plain radiographs if something is looking fishy to me, otherwise have to treat empirically and wait for the result.  CT's can be read after hours by the on call in their underwear at home prn (if they'll approve it of course...we can get head and C Cpine CT's without calling the rad or CT techs after hours).  U/S - if they're sick and think they need one, treat empirically and hold O/N or can send to the urban centre nearby, but they're really good about getting things done quickly the next day for us...DVT's are as EMDPA mentioned - if we're truly worried it's a clot, they get a dose of anticoagulant and they'll usually have had the U/S by the next dose time.

SK

 

[medic25]

Started working a per-diem job in a small community ED last year where we read our own plain films after business hours; coming from a tertiary center with 24/7 radiology in the ED it's a bit of a culture shock.  If there is something you are questioning from an ortho perspective, you can always just go ahead and splint as if there is a fracture.  Just make sure there is a good system in place for the overreads the next day.  I'll often tell the patients that we don't have a radiologist at night, so there is a chance they'll get a call the next day if I don't see something subtle; they generally seem pretty understanding.

[gbrothers98]

Plain films not read from 5p to 8a by radiology. CT read 24/7.

Coping mechanisms:

? missed fracture foot, ankle, finger, hand, wrist, elbow, shoulder-splint/sling, make daytime provider aware to follow up on, inform pt of limitations at night and xray will be overread, may get call.

? missed finding spine, chest, abd & pelvis, KUB, hip/pelvis, knee- CT. You and I are not a radiologist. When miss big finding, legal will ask why you did not CT. Just CT it and don't lose sleep. Either that or work out with radiology group that your calls will be limited (they won't buy that, they are radiologists for a reason).

If you don't have after hours rad or after hours ct then you should be getting a premium, more risk than what I am willing to take on.

Bottom line, protect yourself and the patient from harm. 

George

[kargiver]

Read all my own films.  During "Business hours" if we wait long enough, we get radiology reads, but we are still expected to do all of our own reads.  Also read a lot of my own CTs - the obvious stuff is, well, obvious, but as the years tick by the subtle stuff is much easier to pick up now as well.  We aren't held accountable for CT reads but I don't wait for the Rads to read a CT when I see the subdural or subarachnoid bleed; midline shift is midline shift.  Same for obvious appys, colitis, diverticulitis, perforations, masses, some PEs, etc. 

For U/S, I do my own as well.  I always bring them back for a formal U/S in the morning (I work primarily nights), but unless I am concerned for torsion (ovarian or testicular) or TOA, I treat them accordingly. 

Do enough and you'll get good.  There is no such thing as a "plain film" or a "normal" ultrasound.  Every single image is a teaching opportunity as your knowledge of what is normal, a normal variant, and what is pathologic only comes with repetition. For repetition is the mother of retention.  And that is key when looking for abnormal imaging... what is normal?

G